169

142

.(2547)

.
, .
Evidence-Based Medicine & Clinical Practice Guideline
. (2544). (The Royal College of Medicine of
Thailand, 2001) . (Clinical Practice
Guideline). ,18 (6) : 36-47
.(2545). . 3.
: .
.(2549), 2
:.247-254
Margie A.(2006).Development of clinical pathway for near .Term and Convalescing
Premature Infant in a level 2 Nursery.Journal Advance in Neonate care.6:150164 Received from: http://www.Sciencedirect.com(27/2/2006).
Klaus,M.H. & Kennell,J.H.(1976).Care of the mother. In care of the High risk
Neonate,pp.98-118. edition. Philadephia.W.A.Saunders.
Saigal,S.,Stoskopf,B.,Streiner,D.,& Burrows.E.(2001).Physical growth and current health
status of infant who were of extremely low birth weight and control at
adolescence.Journal of Pediatrics,108(2),407-475.

143

144

Definition Preterm Infant

Preterm-Infant < 37 weeks gestation
Low Birth Weight <2500 gm
Very Low Birth Weight < 1500 gm
Extremely Low Birth Weight < 1000 gm
Small for Gestation Age < 10 th Centime of birth weight for age (John, 2003)
preterm < 37
< 2500 gm.
preterm
glucocorticoid
preterm

32-36 preterm

LBW 2500
VLBW 1500
Preterm infant 37

Post term infant 42

Small for gestational age (SGA):

(SGA) 10rd percentile
Approprirate for gestational age(AGA)
10-90 percentile
Large for gestational age (LGA) 90 percentile

145

..2547
37 12.3 %
6.8 % 1000
35%
4.5
33 36
1 25 50

low birth weight

.
-
-
-
- ,
- ,
.
-
-
- preeclampsia
-
.
- chromosome
- enzyme
- CMV, Rubella

1. 17 34
2.
3.

146

4.

5.
6.
7.

1.



.< 1800 gm

2.


3.


4.
(PDA)

5.

(BPD) (ROP)
6.

147

7.
(NEC) 3 1. 2. 3

NEC ( .
,2548)

Dubowitz Nicolopoulos Ballard 6

6
24

Physical and behavioral characteristics of the preterm

Vernix

Skin

preterm
post term

Nail
20
term post term
Sole crease

32 1-2
36
post term
Breast
form 10
34 36 1-2 .
7-10 .

148

Ear form and cartilage

32
36

Lanugo hair
20

32-34

Genitalia
female clitoris
labia majora 32 labia majora
labia minora
Male testis 30
external inguinal canal
37

muscle tone
(resting posture recoil extremities) caudal cephalic
cephalad
caudal 30
tone 30
flexor tone 34 flexor tone
frog leg flexor tone 35 flexor
tone 36-38
(recoil)
flexor tone 2 muscle tone test

149

technique heal to ear, scarf sign, popliteal angle

(tone)

Joint mobility


test wrist ankle fold test

(preterm infant)
1.Apnea of prematurity
respiratory center

(apnea and bradycardia)
apnea and bradycardia
1.1 Metabolic disturbances hypoglycemia (), hypocalcemia
(), hypothermia
1.2 Sepsis (>2500 gm), meningitis
Gastroesophageal reflux
1.3 Seizure disorder (atonic seizure) intraventricular hemorrhage
apnea of prematurity (REM sleep)
REM sleep apnea
apnea of prematurity 32
<1500
apnea of prematurity
- Theophylline ( aminophylline) dose 5 mg/kg loading dose
2 mg/kg 12o
- Caffeine

150

- Doxapram

apnea apnea of prematurity
2.Respiratory distress syndrome
pulmonary surfactant
alveolar type II cell ,
- oxygen / ventilator support/ surfactant replacement therapy
3. Intracranial hemorrhage (ICH)

connective tissue support sub- ependymal layer
ventricular system
parenchyma brain
4.Necrotizing enterocolitis (NEC)

,
NEC feed
feed
5. Retinopathy of prematurity (ROP)

retina
retina neovascularization retinal detachment
cryotherapy laser retinal detachment vit.E
ROP
6. Hyperbilirubinemia
kernicterus bilirubin level
bilirubin bilirubin
exchange transfusion x 10
1.2 bilirubin exchange 12 /. bilirubin
bilirubin exchange transfusion
7.Poor feeding
coordination
feeding tube 1500-

151

1600 gm.

pan-enteral
8.Metabolic disorder Hypoglycemia /Hypocalcemia
9.Hypothermia
brown fat

1.
-
-
-
-
//
-
2.

-
-
3.

152

1.

( ,
, 2540)

10 %
2

1.

0-6 200 gm/wk

0-3 0.75 cm/wk

3-6 0.50 cm/wk

0-3 0.50 cm/wk

3-6 0.25 cm/wk

(term)
fetal-infant growth graph
Babson (J Pediatr 1976; 89: 814-820.), Ehrenkranz RA, Younes N, Lemons JA, et al:
longitudinal growth of hospitalized VLBW infants. Pediatrics 104: 280-289, 1999.
Healthy LBW AGA; catch-up growth 2
maximum growth rate 36-40 corrected age catch-up growth
3 parameter
catch-up
catch-up growth hydrocephalus

153

LBW SGA catch-up

growth LBW-AGA 50% LBW-SGA
3 15% LBW-AGA SGA
symmetrical SGA catch-up SGA catch-up growth
6-9 9 catch-up
( Ellison PH. 1984)

. 32-34
.

. transitional active
sleep states quiet alert states

( deep sleep states)
.
.

2,000 Human Milk Fortifier (HMF)

(British Columbia
Reproductive Care Program, 2001)
1.
6 colostrums
6-8 100
24
2.
15
30 5

154

8 3

3. skin-to-skin contact (kangaroo care; GA > 28 wk.)
30 kangaroo mother care

4. 32-35
(nonnutritive sucking)
5.
(test weighting)
(
)
6. hindmilk foremilk 3
18.8 (Slusher, Hampton, Bode-Thomas, Pam, Akor, &
Meier, 2003)
( )
syringes ( syringes syringes pump
)
7.
lactation aids
8.
The football hold / The
horse riding hold The C hold (do Nascimento & Issler, 2004)
9.
-
- 10 - 15

-
-
-

155

, ,
Kangaroo care non-nutritive suckling
10-20

35-37 near term infant (The

Academy of Breastfeeding Medicine, 2004)
1. skin-to-skin contact
2. (breastfeeding ad libitum) 8 /
3
3. (dehydration) 3
1 7 3 ( cup
feeding) 5-10 cc. 1
10-30 cc.
4. vitamin D deficiency 200 IU/day exclusive
breastfeeding element iron 2 mg/kg/day ( 1-12 )
5.
. Physiological stability
. Adequate feeding (exclusive breastfeeding and /or with supplements)
. Weight gain 20-30
1 40
(no supplement)
. Recheck weight and jaundice after discharge
. 1
20 0.5
http://www.leron-line.com/PrematureInfant.htm(10/03/50)
(Infant formular) 3

Hypoglycemia

156

./../
2
65
3
80
4
100
5
120
6
150

6-12
3-4 / 150-200 //
120-150 //
4

Hypothalamus

metabolic activity

Hypothermia

1000 35-36
1000-1500 34-35
1500-1800 35.5-34

157

1800-2500 33-33.5
2500-3000
32-33

1.
2.
3.
4.
5.

()

158

1.
2.

3.
4.
5.
6.
7.
8.
9.
10.

159

Apnea

20 Periodic breathing
20 (Apnea)
mask bag 40%
Retrolental Fibroplasia

2.

, , (Sell, Luick, Poisson, & Hill, 1980)

(NBAS)
(<1,500 ) 28-32 38
(Reflex)

40-44
(Brazelton et al, 1987)
(Brazelton,1987)



6
1. (Habituation)

2. (Orientation)

160

3. (Motor Maturity)

4. (Variation)
6

5. (Self-Quieting Abilities)

6. (Social Behavior Scale)

6.1
3

6.2
(Erickson,
1976)
(Reflex)
(Primitive Basic Reflex)
(Reflex)
Moro reflex
10-15

Tonic neck reflex

Placing and Stepping reflexes

161

Rooting reflex

Sucking Swallowing reflex
Plantar reflex (J)

Babinski sign
Palmar grasping reflex

(Brazelton's behavioral State)
6
(Brazelton , 1984)
(Erickson, 1976)
6
(Deep Sleep)
(spontaneous activity)
(Light Sleep)

(Drowsy)
(Sensory)

(Alert)

(Motor activity)

(Active)

(Crying)

162

(Light Sleep)
(Deep Sleep)

(Vestibule Kinesthetic)
(Davis,1993)

: (Crying)
(Chaze & Ludington, 1984)

8 - 12

8-12

(Eye-to-eye contact)

163

5 - 6

(Blackburn,1999)

50
(White-Traut et al, 1997)

164

2 12 /

(Rice, 1977)

Massage beats baby blues

165

3.

50
(Blackburn, 1998)
(2542)

1.

166

167

168

/

/ (Hydrocepharus)

Sensorineural Hearing Loss

1-3
Amino glycoside Diuretic 1,500
(Congenital Infection)
(Corrected Age)

- BCG >2 kg,

- HBV HBsAg 24
HBIG dose 2 kg dose , Vaccine
post natal age OPV NICU Nursery
- BPD (mod-severe) vaccine
6-12 severe apnea
vaccine DPT